Renal transplantation is associated with a better quality of life, lower costs, and longer life expectancy than long-term dialysis. Yet, despite the generally higher prevalence end-stage renal disease (ESRD) among minority populations in the U.S., racial/ethnic disparities in access to care, appropriateness of recipients, and rates of kidney donation and transplantation have all been reported. More specifically, the prevalence of treated ESRD among American Indians (Als) is 3.5 times greater than that of Whites and results, overwhelming, from an excess of diabetes. Using incidence rates with Whites as the reference, the rate ratio of ESRD attributable to diabetes in Als is over 5.0. Additionally, the mean age of onset of ESRD among Als is 6 years younger than among their White counterparts. These statistics speak to an epidemic of ESRD among Als in the next decades. In this project, we will mount a multi-pronged program on ESRD and organ donation at 7 Tribal Colleges and Universities (TCUs) in the Pacific Northwest and Northern Plains. These states are primarily rural, contain medically underserved areas, and have large populations of Als. Because students are among those most likely to donate organs, TCUs offer the possibly of reaching a young, educated, and disease-free population of Als - features which make them desirable to approach about donation. To understand our target population's knowledge and attitudes regarding donation, we will conduct focus groups, then develop culturally appropriate educational materials (brochures, posters) to distribute at TCUs and surrounding communities. We will also create an on-line course on chronic diseases and ESRD, underscoring the need for kidney donation. Our specific aims are to 1) examine knowledge and attitudes regarding kidney donation and transplantation among Als at 7 large TCUs in Washington, Montana, and North Dakota;2) collaborate with students and faculty to develop culturally tailored educational and media materials to heighten awareness of the need for donation and benefits of transplantation among TCU students and surrounding tribal communities;and 3) increase number of Als who consent to donate organs as documented by signed donor cards. Given the striking rates of diabetes and poverty among Als and rural location of most reservations, and the dearth of Al donors, we need understand views on organ donation. More importantly, we need to use this information to increase actual donation rates in this neglected minority.